Report (100) 1515 SUS l 0-'m N,,, -
STATE OF OREGON • ga/ �/7-tW" ��
WELL ID#L 102674
WATER SUPPLY WELL REPORT
(as required by ORS 537.765) SKV' ES DRILUNG,, INC. START CARD# W1038063
Instructions for completing this report are on the last page of this orm
13
(1)OWNER: Well Number: 91 (9)LOQ A ON OF WELL by legal description:
Name County Washiggton Latitude Longitude
Unitad_Excavators,_incl_PotygDn Township N or S. Range E or W.of WM.
Address 4.8524_NW�sthanyBlxd,Ste.a-2P11113_367 2;1:1a 1W 1/4
City TPortland State OR Zip 9Z224 Section OgD.G.— S]tY va SE __1/4
Tax lot Q0i91Lot Black Subdivision
(2)TYPE OF WORK: Street Address of Well(or nearest address)-1.5.51.5,SW.1.50th.Ave, —
New Well 0 Deepening Alteration(repair/recondition) al Abandonment TIgard.Q-g---
�— (10)STATIC WATER LEVEL:
(3)DRILL METHOD: 250 ft.below land surface. Date 3123/2018_
X Rotary Air ❑Rotary Mud ❑Cable ❑Auger Artesian pressure lb.per square inch. Date
Other
(11)WATER BEARING ZONES:
(4)PROPOSED USE: W Depth at which water was first found N/A_
'Xi Domestic ❑Community ❑Industrial ❑Irrigation �
Thermal ❑Injection ❑Livestock El Other , ,From ? To __ at '/ L
(5) BORE HOLE CONSTRUCTION: {p
Special Construction approval `,Yes i X No Depth of Completed Well Si ft. DEC 1 8 2011)
Explosives used _.Yes X'No Type Amount
HOLE SEAL Amount C,�®F (IH
Diameter From To Material From To I sacks orpounds (12)WELL LOG: t�n tttA�'' (\/iQIf'1it.±
6 Cement w/5% 400 Ground Boii:uli m
I bentonite 7 57 Sacks Material From To, ' SWL
i i I Bentonite i 7 0 2 Sacks — — —
-------� AbandanmentOnlyofl+lyASH 69250
I I Calculated 55 Sacks [Original Start Card W204823_
How was seal placed: Method EA ❑B ❑C ❑D 0 i
X Other ..umpeCL,1t.b9_ttorn;Pouresikentonite
Backfill placed from ft to ft. Material
Gravel placed from ft.to ft. Size of gravel
(6)CASING/LINER: I
Diameter From To Gauge i Steel Plastic Welded Threaded
Casing: 6 0 ! 263 I .25(11 X; L KYLE.5-3d G
I I I ❑ ❑ :x-656-2683--
❑ 0 1
Liner: P_U,I IGd_1 __; 1 ❑ La
Drive Shoe used L❑Inside ❑Outside ❑None
Final location of shoe(s) NIA ,
(7)PERFORATIONS/SCREENS:
_ Perforations Method CAm_oniS.eal-NoJ eJfs
_ -Screens Type Material
Slot Tele/pipe
From To size Number Diameter size Casing Liner
None i
rl
Date started 3123/209.8 Completed 3l28iao1a
❑ (unbonded)Water Well Constructor Certification:
Li I certify that the work I performed on the construction,alteration,or abandon-
ment of this well Is in compliance with Oregon water supply well construction
(B)WELL TESTS:Minimum testing time is 1 hour standards.Materials used and information reported above are true to the best of my
Pump J Bailer _t Air Li Flowing Artesian knowledge and belief
i WWC Number 200.3
Yield gal/min Drawdown Drill stem at Time Signed 1-"r---1--" Date 3/28/2018 _.
N/A Sk%lea Drilling,Inc.
i (bonded)Water Well Constructor Certification:
i I accept responsibility for the construction, alteration, or abandonment work
i performed on this well during the construction dates reported above. All work
Temperature of Water Depth Artesian Flow found performed during this time is in compliance with Oregon water supply well
Was a water analysis done? `Yes By whom construction standards. This report Is true to the best of my knowledge and belief.
Did any strata contain water not suitable for intended use? 7 Too little .---' WWC Number 1998
Salty _ Muddy _Odor --Colored )_:Other Signede "`----— Date
Depth of strata: --__, 31281207.8_
Skyles Drilling, Inc.
ORIGINAL-WATER RESOURCES DEPARTMENT FIRST COPY-CONSTRUCTOR SECOND COPY-CUSTOMER
,zy /2-- ods-Y
RECEIVED
DEC 182018
CITY OF TIGARD
BUILDING DIVISION
P.O.BOX 1050
v.S. GASTON,OR 97119 R I! At/ INVOICE# 09368
503-522-2727 OFFICE
503-687-2881 FAX DATE •, ! __._..��'''��
• ORIGINATION �i TECHNICIAN -' 7(503) CUSTOMER �7# l4k� _ ( ADDRESS 7'i$/l SKJ /51.1t1-
CITY
j� ;, ) € - i l CITY AJ' STATE f7 ZIP q ��
522-2127 c 1 BEST PHO E# ( �j ) s /-'S'7o"�-
CCB#202772
CONTACT# ( )
CEO#30277 FAX# ( ) TIME IN gs PD PM
PLUMBING#PB1466 ❑YES DAYS_ GUARANTEE `
®NO TIME OUT �.Sl (PM
NEED FLAT/
ORK PERFORMED DRAINCLEANING
HOURLY ADD.DRAINS •
a,/ t- A, , S♦ SEPTIC PUMP SEE -
KITCHEN SINK FLAT -Th 4,0'114 PI; SAIIP1�hJq GREASE PUMP
LAUNDRY LINE FLAT lJ VIDEO INSPECTION
BATH SINK FLAT PIPE LOCATE
BATH TUB FLAT WATER JETTING
VIDEO HOURLY EXCAVATION, a
TOILET FLAT ,/,:... PRODUCTS
FLOOR DRAIN FLAT / _y X44 PARTS
AREA DRAIN HOURLY LABOR
RAIN DRAIN HOURLY #0°1 t ) DIAGNOSIS FEE
SEPTIC/GREASE GAL. :2/9 SS r,° ✓1
SERVICE CALL
VIDEO HOURLY
ROOF/2ND FLOOR
SECOND MAN
APPROVAL CODE# CHECK# PLUMBING
-
PARTS % RECOMMENDATIONS
lilaDESCRIPTION I!ENZYME TREATMENT L 1VIDEO INSPECTION
aliii= V6OT KILLER ❑PIPE REPAIR/REPLACEMENT 5%CC FEE
,W_ NUAL MAINTENANCE 0 CLEANOUT/INSTALLATION TOTAL c'
No
WATER JETTING ...r---
PAYMENT RECEIVED
'''N\ BALANCE DUE 5
ADDITIONAL TERMS AND CONDITIONS CONTAINED ON
THE REVERSE SIDE OF THIS SHEET
WEBSITE:WESTSIDEDRAIN.COM i
EMAIL:WESTSIDEDRAIN@ICLOUD.GUM ::CEPT 'N
CEP-CANOE OF ES IMA AND TERMS AND DITIONS AC. 1 OGEMENT OF COMPLETION
•
a ,l
SITE COPY BUILDING PERMIT
CITY OF TIGARD i
114 ■: COMMUNITY DEVELOPMENT Permit if: BUP2017-00154
13125 SW Hall Blvd.,Tigard OR 97223 503,718.2439 Date Issued: 07/13/2017
T[rJ A It L� 9 Parcel: 2S 108DC01401
Jurisdiction: Tigard
Site address: 15515 SW 150TH AVE
Project:River Terrace Crossing Subdivision: None Lot: None
Project Description: Demo(1)3,509 sf dwelling on septic. UPON FINAL INSPECTION,DEMO CREDITS FOR SDC FEES MAY
APPLY.
Contractor: NORTHWEST EARTHMOVERS INC Owner: NEIDERS,REGINE I&GUNARS K
PO BOX 1609 14517 SE 178TH PL
SHERWOOD,OR 97140 RENTON,WA 98058
•
PHONE: 503-625.3100 PHONE:
FAX:503-625-3108
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/13/2017 $423.53
Demolition
Occupancy Grp: Occupancy Loud:
Info Process/Archiving-Sm$0.50(up to 07/13/2017 $0.50
Dwelling Units: 1 11x17)
Stories: Height: ft Erosion Control w/Development 07/13/2017 $80.70
Bedrooms: Bathrooms:
Value: $22,650
Floor Areas:
Total Area:
Accessory Structs
Basement:
Carport:
Covered Porch:
•
Deck:
Garage:
•
Mezzanine:
Total $504.73
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
This permit is issued subject to the reguleliuns contained In No Tigard Municipal Code,Stale of OR.Speciefty Codes and all other applicable law. All work will
be done In accordance with approved Hove.This permil will expire If work le not started within 180 days of issuance,or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rubs adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 0// �022-001-0090.You may obtain a copy off the�rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.233444.
leauetl By: .�ri A,a'�iLGL�/ Permittee Signature: �.��
�
/GG1G� "
/
Cen 603.639,4676 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept ina conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each Inspection.
Inspections Required for T nit No.: gue2 7/7-c
IVR Code Type Permit Description IVR Code Type Permit Description
01 BUP Building—structural 07 SIT Site Work
02 ELC Electrical 08 SWR Sewer Connection
03 ELR Restricted Energy 09 FPS Fire Protection
04 MEC Mechanical 10 RER Re-Roof
05 MST Master—residential combination I I CMS Commercial Manufact.Structure
06 ELM Plumbing 12 SEM Single-Family Manufact.Structure
J Req'd I Code I Inspection Description I Req'd Code Inspection Description
Building(structural)Inspections Electrical Inspections
205 Footing 105 Underground/slab cover
210 Foundation walls 110 Temporary electrical service
215 Footing drain 115 Electrical service
220 Slab 120 Electrical rough-in
225 Post/beam structural 125 Wall cover
230 Underfloor insulation 130 Ceiling cover
240 Exterior shearwall 135 Low voltage rough-in
242 Interior shearwall 140 Sign installation
245 Firewall 145 A/C or heating unit circuit
250 Roof nailing 150 Hot tub/spa/pool
255 Wtr proofing basement walls 195 Misc.inspection
260 Tilt-up panel 198 Low voltage final
265 Masonry 199 Electrical final
270 Reinforcing steel(rebar)
275 Framing Mechanical Inspections
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough-in
289 Approach/sidewalk 620 Hydronic piping
295 Misc.inspection 625 Ductwork
299 Final inspection 630 Fire damper
635 Smoke detector shutdown
Fire Protection System Inspections 640 Exhaust hood
901 Sprinkler supply lines 645 Grease duct test
905 Sprinkler underfloor/slab 695 Misc.inspection
906 Flush test 699 Mechanical final
907 Sprinkler hydro test
910 Sprinkler rough-in/test Plumbing Inspections
915 Fire alarm rough-in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc,inspection 312 Backwater valve
998 Alarm final 315 Post/beam plumbing
999 Sprinkler final 320 Plumbing rough-in
322 Shower pan
Site Work Inspections 330 Water service
405 Excavation 335 Rain drain
410 Fill 340 Storm sewer
415 Grading 345 Culvert/catch basin
495 Misc Inspection 350 Septic tank
499 Final Inspection 395 Misc.inspection
399 Plumbing final
Sanitary Sewer Inspections
505 Sanitary sewer
Erosion Control Inspections 585 Misc.inspection
>"*" 750 Initial erosion control 599 Final inspection
752 LIDA on-site facility inspection
755 Regular erosion control Manufactured Structure Inspections
797 Final LIDA inspection 810 MFG-Structure set-up
798 Final erosion control 899 MFG-Structure final
1:\Building\Forms\Inspection Cards\AOP hasp Card By Case\tnspCacd_AlLo3tet6.docx
k.
•
•
st
1 i 1 1 1 l / -^ i "� 4//,,}( \ \ ', `. A vv lar,5m; ',�
I 1 11 /1 11 / Ki
1 �yI/i Eccri�e(R ,� mx.r-sx.�%--=5 _ %T\Y_ , .. x.s a� X—X�=-X—�%—X—% • - 1=,..I(y*f5�,
` 1
�.^`•_\ I ! �F_ ruRor:Ism ^-_�\\ /��^ lIIFi n ..� �_ - \\ \ •\ \\"\ _`'�\-- 1 .e i>: D: x
i
\.�� ' \\ / /' -I \ •x %.j,J///+I�/�.( {—x—\=x-�—=/x %—x-yl—x x.x—x—x -- x—z-rX—x X—X=,..-..„2,—x= . 'II
•\ 1Jr%
/.. I //' i I\ r
` \� i •
/ 1\ /—\..^^\\� 4'I. \ \ I` / \ \\ \ \ fIOSTNGDRPE.VIAY
/ Il 1 1 ( , / ' ^/ t,',/,
, \
\,\/ \ \ \ ovum FOR OMTNK'iT.H
1 / // ( . .' l T\\ `\ \\ \�\ TORE : '2
I. ,� �' TREE PaDreLN/x FLTLEE / / — ^�\ I 1 ` % \ ----x--x x�
O�/ 1 8 l I �b / \ `T l l \ �J� POLYGON NV/GQA{EAHY
/� / i ..l Ol•/. : \ \ \ )�_ HIL ',BUMSifxcd\ \t\`�� ___ _ '.
�\,15 / , \ 8 i 1` fT" N / \\0 ; /�� \TAXlOT:III \\ 'aTO RE IRAVYAN " ^_�
xX I 5s ' \l / / �� f1451NG SMfIM L� /\ \ �!_`C, /^`\ \ `.
r- r
O I 1 1, / 1D / TO RNA. 00 TREE PROTfCTRMiENCf\\ \ I "dBM+a RIOM#.WAY p
//66 ,�Iyy. Pacific�� ; i i i ; " sD sTEAMeIRYEx ��/ `\ + \/ h~ \�R ��_ , ± Community
r / e
1 ,` ( ; ; c I ,/ \, : \. ,......„,, �_`\` ., Design
11
', '' t r \ ` ` 0 � ♦ ', `\ \ \\Z`^E%ISTNG ffMES\`\\` .\ INSTALL E
/, Il I /% 1 �, \ \ !.�'/ 1 1 I \ -�Q{.��``_ �' ` GEODETIaN:m<.
t
PP
1 I. REVISIONS
A 1 I I <' ; 1. '$ \ TO BE REMOVED XK' �� DATE DESCRIPTION
FAI / / 1 I I 1 T I .--. r / \ \ \ x_/-%—x Y% %—%—X=x-•-^! X—X—x—x—x—%
I
% ; 15 l I ,� \ / \ _I \\TAILOT:1.001 1 \ \..- I
ri
LEGEND �y"'/,J /� /"}
I I SIDEWALK —DDE— STORM ORAN LINE 1 GUY WIRE ® TELEPHONE RISER L.YC / -20/7— 7tT/�'
I I PAVEMENT —
ST'— WATER LINE ® SANITARY SEVER MANHOLE ® DITCH INLET .s.. .
I GRAVEL
—¢— ELECTRIC LINE ® STOMA0RMNMAIMOLE 0 NE
VEONFLECERXALBW SITE COPY
L_I BUILDING —.O— TELENIONE INE WE FIRE NYDPAM 0 IRRIGATION CONTROL VALVE
CZ,: WETLANDS
—xx— TAS LINE + su. ® UTILITY RISER
I�i''1 $MfAM -0_ TREE PROTECT ION FENCE I WATER METER PI GAS VALVE
—%—%—FENCE 10 E' mamma • WATER VALVE 41111FLOW DIRECTION 1I
—VIx—OVERHEAD WIRES O LIGHT POI[ 0 CNB INLET X TREE TO RE MOVED n��u.ss„vr""�
n. —ns—UNWARY SEWER NIM ® [I.ECTRIGLRISER B MAILBOX River Terrace
Crossing
KConstruction Documents
7..,.‘=° /AN PEW F O D
€ 0„„,...„,..,. , my
a' rYo EROSION AND
v ;kI H o n SEDIMENT
° R.., m,"a_ m —1 CONTROL PLAN
PROFn F 1 r K, , TAX LOT 1401
1/41
Dam uH ~>' J.,,,,,,..,,.,,,,,,,,,,, ,- .,W R.P —,7 _5
"— 11 1 ss W suwmru Auxn
rtxcE srlaLE loLULY FRONT CREW ,' 1 CRY
srsuWMTTAL uss/mn
SMIN LINK MACRO°. NialBEIOGTCDAT TMP°. '" •'��� t
3 1.1ArongL WRWMSMN 1058 .• PERMETERO'TMCRITICAL
15
g ROOT iON[. -- _'xB.
IE O TREE PROTECTION DETAIL TO ..
TMe PROiECibx PUN p'^'"°.^� .» 63)
CRITICAL ROOT EOM IfSMET
(NOT Ta SGLEI of PROTECTED SEDIMENT FENCE I>a
. s 155 , 5L) 16011.1A)b 1
S J ,��SCALE��,,
R G CAC
1 INCHELEVATION DATUM:NOVO 29 Do FEET